Abstract
ObjectiveAlthough risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders.MethodsNational Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed.ResultsAltogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%–8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4–8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk.ConclusionsOverall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%–8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.
Highlights
Suicide is an important cause of death worldwide, and about 1.5% of all deaths are by suicide [1]
This review included nationally representative, register-based studies reporting on suicide mortality of diagnosed psychiatric patients with unipolar depression or bipolar disorder
Eleven Danish [15,16,17,18,19], Finnish [20, 21], Norwegian [22], and Swedish [23,24,25] studies reported on rate and risk of suicide in unipolar depression (Table 1). They found between 2% and 8% of psychiatric inpatients with depression to have died by suicide
Summary
Suicide is an important cause of death worldwide, and about 1.5% of all deaths are by suicide [1]. For suicide prevention overall, monitoring suicide mortality, knowledge of risk factors for suicide, and provision of adequate treatment for patients with mood disorders are central tasks. Over decades of work in this field, advances have been made in the knowledge of risk factors for suicide, and this information has been condensed into risk estimates in important meta-analyses [7, 8]. As such documents reveal, for many important risk factors uncertainty prevails due to limitations of the samples available. Scarcity of representative contemporary diagnosis-specific data is a major problem, despite a great need for monitoring rates of suicide in these central patient groups
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